Individual provider Active NPI

Tracy Lynn Johnston, NP- C

  • Family Nurse Practitioner
  • Boise, ID
National Provider Identifier
1548693682
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-1311 A Issued in ID
Practice address
1910 University Dr
Boise, ID 83725-1351
Phone
(208) 426-1459
Fax
(208) 426-3005
NPI assigned
Aug 13, 2013
Last updated
Aug 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-1311 A ID Primary

Addresses

Primary practice location

1910 University Dr
Boise, ID 83725-1351

Mailing address

1910 University Dr
Boise, ID 83725-1351
Phone (208) 426-1459

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160621000415 ID Practitioner - Nurse Practitioner 5193016277 Reassigns benefits to 1 organization
I20160621001132 OR Practitioner - Nurse Practitioner 5193016277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

333 N 1St St
Suite 110
Boise, ID 83702-6115
Phone (208) 381-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-1311 AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Family Medicine CurrentSince May 5, 2016 Accepting new patients
St Lukes Regional Medical Center PastSince May 5, 2016 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2235

333 N 1st St
Ste 110
Boise, ID 83702
Phone (208) 381-3000

333 N 1st St
Ste 140
Boise, ID 83702
Phone (208) 381-7353

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

3101 E State St
Ste 2120
Eagle, ID 83616
Phone (208) 473-3275

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

3950 17th St
Baker City, OR 97814
Phone (541) 523-1001

Interoperability endpoints

  • Direct secure messaging: tjohnston40035@direct.slhs.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1548693682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 UNIVERSITY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837251351",
            "telephone_number": "208-426-1459",
            "fax_number": "208-426-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 UNIVERSITY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837251351",
            "telephone_number": "208-426-1459",
            "fax_number": "208-426-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "TRACY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "NP- C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1311 A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.